Med 201 - The Endocrine
System test questions and
answers
Pharmacological Treatment of Diabetes:
INSULIN
SULFONYLUREAS
BIGUANIDES
THIAZOLIDINEDIONES
MEGLITINIDES
ALPHA GLUCOSIDASE INHIBITORS
LIPASE INHIBITORS
GLP-1 AGONISTS
DPP-4 INHIBITORS
SGLT-2 INHIBITORS
AMYLINOMIMETICS
BILE ACID SEQUESTRANTS
DOPAMINE AGONISTS
Drug interactions with anti-diabetic agents
Decrease blood glucose → increase effects of anti-diabetic agents:
- NSAIDs
- MAOIs
- beta antagonists (non-selective)
Increase blood glucose → decrease effects of anti-diabetic agents:
- Corticosteroids
- Thiazide diuretics
,- Thyroid agents
- Sympathomimetics
Insulin:
(Diabetes treatment)
MOA - Insulin interacts with extracellular binding sites (alpha
subunits) on membrane-bound tyrosine kinase linked receptors ⇒
autophosphorylation of beta subunits ⇒ signal transmission to
inside of cell ⇒ activation of anabolic pathways or inhibition of
catabolic pathways ⇒ biological response.
Use/Treatment of - Type I Diabetes Mellitus (absolute insulin
deficiency), Type II (relative deficiency and/or insulin) if not
adequately controlled w oral drugs and Gestational Diabetes.
Physiological effects/Side effects/Adverse Rxns - Hypoglycemia ( >
diaphoresis, vertigo and tachycardia), Allergic reactions,
Lipodystrophy (rare), weight gain. Alcohol, salicylates and beta
antagonists potentiate hypoglycemia. Corticosteroids increase
insulin requirements.
ADME - SC, IV for emergency use. Rapidly inactivated by proteolytic
enzymes (so not PO). Administered with glucose to treat life-
threatening hyperkalemia. Redistributes K into cells. Metabolized in
liver & other tissues.
Insulin Analogues:
REGULAR INSULIN
LISPRO
ASPART
GLULISINE
Preparation:
Prandial bolus
Onset:
Regular 0.5 - 1 hrs
Lispro, Aspart, Glulisine 0.1 - 0.25 1 hrs
Peak:
Regular 2 - 3 hrs
, Lispro, Aspart, Glulisine 0.5 - 3
Duration:
Regular 6 - 8 hrs
Lispro, Aspart, Glulisine 4
Usage:
Meals or acute hyperglycemia
Insulin Analogues:
NPH (modified insulin + protamine)
GLARGINE
DETEMIR
Preparation:
Basal
Onset:
NPH, Glargine, Detemir 2 - 4
Peak:
NPH 4 - 10
Glargine, Detemir None
Duration:
NPH 12 - 18
Glargine 20 - 24
Detemir 20 - 23
Usage:
NPH Basal insulin, pregnancy
Glargine, Detemir Basal insulin
Biguanides:
(Diabetes treatment)
Metformin
MOA - Unlike insulin & insulin secretagogues, Metformin assoc
lowering of serum lipids & weight loss. Suppression of hepatic
glucose synthesis
System test questions and
answers
Pharmacological Treatment of Diabetes:
INSULIN
SULFONYLUREAS
BIGUANIDES
THIAZOLIDINEDIONES
MEGLITINIDES
ALPHA GLUCOSIDASE INHIBITORS
LIPASE INHIBITORS
GLP-1 AGONISTS
DPP-4 INHIBITORS
SGLT-2 INHIBITORS
AMYLINOMIMETICS
BILE ACID SEQUESTRANTS
DOPAMINE AGONISTS
Drug interactions with anti-diabetic agents
Decrease blood glucose → increase effects of anti-diabetic agents:
- NSAIDs
- MAOIs
- beta antagonists (non-selective)
Increase blood glucose → decrease effects of anti-diabetic agents:
- Corticosteroids
- Thiazide diuretics
,- Thyroid agents
- Sympathomimetics
Insulin:
(Diabetes treatment)
MOA - Insulin interacts with extracellular binding sites (alpha
subunits) on membrane-bound tyrosine kinase linked receptors ⇒
autophosphorylation of beta subunits ⇒ signal transmission to
inside of cell ⇒ activation of anabolic pathways or inhibition of
catabolic pathways ⇒ biological response.
Use/Treatment of - Type I Diabetes Mellitus (absolute insulin
deficiency), Type II (relative deficiency and/or insulin) if not
adequately controlled w oral drugs and Gestational Diabetes.
Physiological effects/Side effects/Adverse Rxns - Hypoglycemia ( >
diaphoresis, vertigo and tachycardia), Allergic reactions,
Lipodystrophy (rare), weight gain. Alcohol, salicylates and beta
antagonists potentiate hypoglycemia. Corticosteroids increase
insulin requirements.
ADME - SC, IV for emergency use. Rapidly inactivated by proteolytic
enzymes (so not PO). Administered with glucose to treat life-
threatening hyperkalemia. Redistributes K into cells. Metabolized in
liver & other tissues.
Insulin Analogues:
REGULAR INSULIN
LISPRO
ASPART
GLULISINE
Preparation:
Prandial bolus
Onset:
Regular 0.5 - 1 hrs
Lispro, Aspart, Glulisine 0.1 - 0.25 1 hrs
Peak:
Regular 2 - 3 hrs
, Lispro, Aspart, Glulisine 0.5 - 3
Duration:
Regular 6 - 8 hrs
Lispro, Aspart, Glulisine 4
Usage:
Meals or acute hyperglycemia
Insulin Analogues:
NPH (modified insulin + protamine)
GLARGINE
DETEMIR
Preparation:
Basal
Onset:
NPH, Glargine, Detemir 2 - 4
Peak:
NPH 4 - 10
Glargine, Detemir None
Duration:
NPH 12 - 18
Glargine 20 - 24
Detemir 20 - 23
Usage:
NPH Basal insulin, pregnancy
Glargine, Detemir Basal insulin
Biguanides:
(Diabetes treatment)
Metformin
MOA - Unlike insulin & insulin secretagogues, Metformin assoc
lowering of serum lipids & weight loss. Suppression of hepatic
glucose synthesis
